Non-alcoholic fatty liver disease linked to coronary artery disease

Because of the prevalence of obesity in our country, many Americans are expected to develop a serious condition called non-alcoholic fatty liver disease (NAFLD), which can lead to cirrhosis, fibrosis, and in some cases liver failure. It is also one of the best predictors for coronary artery disease.

"Most people who have fatty liver disease are more likely to die from a heart attack than cirrhosis of the liver," said Dr. Howard Monsour, chief of Hepatology at The Methodist Hospital in Houston. "I ask all my patients, especially those over 50, if they have had a stress test in the last year; if not then I send them to the cardiologist to get one."

NAFLD is fat inside the liver cells. Alcohol, drugs, obesity, lipid disorders and diabetes can all be causes. However, many with this condition suffer from Metabolic Syndrome, a constellation of factors which include a large waist circumference (men greater than 40 inches, women greater than 35 inches), high blood pressure, high triglyceride levels and insulin resistance that heighten the risk of heart attack, stroke and type 2 diabetes.

"Data has shown that nearly 30 million Americans have NAFLD. Many times it is missed until the person's liver enzyme levels are high," said Dr. Kathleen Wyne, director of clinical research for the Diabetes Research Center at The Methodist Hospital Research Institute (TMHRI). "Much like type 2 diabetes, it can be cured with diet and exercise."

"Vigorous exercise, such as weight lifting, swimming, running or aerobics, between 75 and 150 minutes a week with a heart rate of 120 or above will help you tackle this problem," Monsour said. "If you lose 12 percent of your current weight, no matter how much you weigh, you can also eliminate fat from your liver."

Between five and 20 percent of people with fatty liver will develop serious liver disease. Developing cirrhosis, fibrosis or liver cancer depends on whether the person has inflammation in the liver caused by the fat resulting in an inflammatory response called steatohepatitis. This often, but not always, causes liver enzyme elevation on routine blood tests.

"The key is to catch it early. If we do, we can help the patient avoid cirrhosis, fibrosis and type 2 diabetes," Monsour said. "Letting it go without evaluation can lead to liver disease, liver cancer, stroke, heart disease and a very difficult life."